人类免疫缺陷病毒并乙型肝炎病毒感染者终末期肝病影响因素分析

Logistic regression analysis for risk factors related to end-stage liver disease among HIV/HBV coinfection patients

目的了解影响人类免疫缺陷病毒（HIV）合并乙型肝炎病毒（HBV）感染者发生终末期肝病的影响因素。方法对HIV合并HBV感染者进行调查，对影响终末期肝病的因素进行非条件logistic回归分析，计算比值比（彻）。结果255例HIV合并HBV感染者终末期肝病发生率为19．2％（49／255）。基线CD4〈200／μl、基线氨基转移酶异常、抗反转录病毒治疗6个月内HIVRNA降至检测下限、HIVRNA和HBVDNA持续阳性时间较长、使用含拉米夫定的抗反转录病毒治疗方案最终进入多因素分析的回归模型，OR值分别为6．503、14．456、0．049、1．814、1．536、0．012。结论HIV合并HBV感染者发生终末期肝病的风险与患者免疫功能、肝功能、HIV及HBV持续复制密切相关；为降低终末期肝病发生率，HIV合并HBV感染者宜首选含拉米夫定的抗反转录病毒治疗方案。

Objective To understand major risk factors associated with end-stage liver disease （ESLD） among patients with human immunodeficiency virus （ HIV ）/hepatitis B virus （ HBV ） co-infection. Methods Patients with HIV/HBV co-infection were followed-up and factors related to ESLD were analyzed using logistic regression model to estimate odds ratios （ORs） for them. Results A total of 255 patients with HIV/HBV co-infection were investigated, with an incidence of ESLD of 19. 2% （49/255）. Major risk factors associated with ESLD among patients with HIV/HBV co-infection included count of CD4 below 200 cells/μl at baseline, HIV RNA load decreasing to the lower limit of its detection level within six months after antiretroviral treatment （ART）, abnormal of serum activities of transaminase （ALT or AST ）, longer persistently positive of HIV RNA and HBV DNA, and use of lamivudine-based ART, with OR of 6. 503, 14. 456, 0. 049, 1. 814, 1. 536 and 0. 012, respectively. Conclusions Lower CD4 count, abnormal serum transaminases, persistent replication of HIV and HBV all are closely related to ESLD in patients with HIV/ HBV co-infection. Therefore, lamivudine-based ART should be of choice for patients with HIV/HBV co- infection to decrease incidence of ESLD.